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04-0824_ALL AMERICAN ASPHALT_Certificate of InsuranceCERTO F Ii # iM? DATE IMMIUD/YY) -. 8/24/04 PRODUCER- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Calco Ins Brokers 8 Agent HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lie. No. OB29310 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE 500 City Pkwy West, Ste. %500 COMPANY Orange CA 92868-2946 (714) 937-1824 A Arch Specialty Insurance Co. INSURED COMPANY All American Asphalt B Hartford Fire Insurance Co. PO Box 2229 COMPANY Corona, CA 92878-2229 C Great American insurance Ca COMPANY Seabright Insurance Co .:CowWait THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOLICY PERIOD INDICATED,NOT W ITHSTANDING ANY REOUIREMENT,TERMOR CONDITION OFANYCONTRACT OR OTHER DOCUMENT W ITHRESPECT TO W HICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE DATE MIDDIYY) POLICY EXPIRATION DATE(MMIDDIYY) LIMITS A GENERALLIABILITY 326PP0535900 8/01/04 8/01/05 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP ADD $ 2,000,000 X COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED 6 CLAIMS MADE FX OCCUR PRIMARY WORDING APPLIES PERSONAL A ADV INJURY $ 11000,000 OWNER'S& CONTRACTOR'S PROT ONLY IF REQUIRED BY EACH OCCURRENCE S 11000,000 FIRE DAMAGE (Any one fire) $ 50,000 X 4100,000 SIR CONTRACT MED EXP (Any one person) $ B AUTOMOBILE LIABILITY 72UENSK5491 K2 8/01/04 8/01/05 COMBINED SINGLE LIMIT S X ANY AUTO 1,000,000 BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAOELIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO N/A EACH ACCIDENT S AGGREGATE $ C EXCESS LIABILITY TUE5950076 8/01/04 8/01/05 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 UMBRELLA FORM Is OTHER THAN UMBRELLA FORM D WORKERS COMPENSATION AND BB1040243 8/01/04 8/01/05 X STATUTORY LIMITS EMPLOYERS'LIABLITY EACH ACCIDENT $ 11000,000 THE PROPRIETOR/ )( INCL PARTNERS/EXECUTIVE DISEASE - POLICY LIMIT $ 11000,000 DISEASE EACH EMPLOYEE S 11000,000 OFFICERS ARE: EXCL OTHER N/A DESCRIPTION OF OPERATIONSILOCATIONBIVEHICLESISPECIAL ITEMS RE: Rancho Viejo Road Rhabilitation, Malaspina Road to 1700 Feet South (CIP No. 120) '10 days notice for nonpayment of premium 2ax• so GERT9FIGATE HpLLlSR GA:10E.W.AT* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of San Juan Capistrano EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDWW{ION(X90(NXAL Public Works Dept. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: Brian Perry BXR)gMIKMWW)MYAW)DOMYMKK)NWAtXXNWKtlNKMU) WU(WXXKM)LWX)NWIMWXXXX 32400 Paseo Adelanta OFT(X90[XXXMWXXNWMXX70WD)MR1AKMXXWXXY)gWN11W(X9(NXXNWANNNKXWAXOM AUTHORIZED REPRESENTATIVE San Juan Capistrano, CA 92675 053011 ACORG18S•S 9183 AGpRA�#7APUAAT9f�N X583: CERTIFICATE: 208/001/ 02138 c 11 . • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED SECTION III — WHO IS INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with the Named Insured to be named as an additional insured, but only with respect to liability arising out of your operations, "your work", or premises owned by or rented to you. All other terms and conditions of this Policy remain unchanged. City of San Juan Capistrano and its elected and appointed officials PROJECT: Rancho Viejo Road Rehabilitation, Malaspina Road to 1700 Feet South (CIP No. 120) Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: 32GPP0535900 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/04 00 CGL0006 00 02 04 cAMy Oocs\ALL\Endt.doc CALIFORNIA PRELIMINARY NOTICE (California Civil ecriort 3097 as amended by Senate Bi(( 1379 [Chapter 3961'ive January 1, 1978) Notice to Property Owner -If bills are not paid if full for a labor, services, equipment or materials famished or to he furnished, a mechanic's lien leading to the loss, through court foreclosure proceedings, of all or part of your property being so improved may be placed against the property even though you have paid your contractor in full. You may wish to protect yourself against this consequence by (1) Requiring your contractor to famish a singed release by the person or firm giving you this notice before making payment to your contractor, or (2) Any method or device that is appropriate under the cirarmstances. Other than residential homeowners of dwellings containing fewer than five units, TO: CITY OF SAN JOAN CAPISIRPNJ X GwNER Name of person or firm famishing REPUTED OWNER 32400 PASEO ADELANTO OR NM£ PUBLIC AGENCY SAN JUAN CAPISPRAN), CA 92675 Dated September 28, 2004 OCSS JOB NUMBER 434002 YOU ARE HEREBY NOTIFIED That the undersigned has furnished or will famish labor, services, equipment or materials of the following description. STRIPING, STENCILS, SIGNS, SANDBLASTING, MARKERS, THERMOPLASTIC, GUARDRAIL, BARRICADE For the building, structure or other work of improvement located at RANCHO VIEJO ROAD REHABILITATION MALASPINA ROAD TO 1700 FEET SOUTH OF MALASPINA ROAD THE NAME AND ADDRESS OF THE PERSON WHO CONTRACTED FOR THE PURCHASE OF SUCH LABOR, SERVICES, EQUIPMENT OR MATERIAL IS: SEE BELOW ALL AMERICAN ASPHALT (JOB 16211) TO: mtr P.O. BOX 2229 OR CORS, CA 92878-2229 S ti E Name of person or firm famishing labor, semee equipment or matenal NAddress NM£ D w AEIFESS E By IE(� R IL NONE REPORTED This acknowledges remipt on Trust funds to which supplemental fringe benefits are payable NAME ti 7 nmais NM£ w AEIFESS Materia( men not required tojumish the above ORANGE COUNTY STRIPING SEF 183 NORTH PIXLEY STREET - I i1fifil=2111 i s 101 J M d 7_TrImUi it INC. - LIC.#346095 GE, CA 92868 Date September 28, 2004 NOTICE TO CONSTRUCTION LENDER ONLY Estimated total price of the labor, services, equipment or materials described hereon. ACKNOWLEDGMENT OF RECEIPT OF PRELIMINARY 20 -DAY NOTICE (Sectio. 3097.1, Calif Civil Code) (Date) (Date this acknowledgment is eaeared) detach creepy of Nis prelaninary 20 -day notice at (Address where Notice received) (Signature ofperson acknowledging-cceipp with title ofacknowfedgmem is made on behalfof another person) and mtam same to sender -CA- Iola --i,' I °-"i-t